| Prevention of neointimal hyperplasia associated with modified stretch expanded polytetrafluoroethylene hemodialysis grafts (Gore) in an experimental preclinical study in swine. | |
| | |
MedLine Citation:
|
PMID: 21944911 Owner: NLM Status: Publisher |
Abstract/OtherAbstract:
|
OBJECTIVE: Stenosis is the main cause of hemodialysis vascular graft failure and it is primarily caused by neointimal hyperplasia (NH) development at the vein-graft anastomosis. Even though NH development factors are well known, their activation pathway still remains disputed and the real role of the mismatch compliance between the vein and the graft wall has not yet been resolved. The purpose of this experimental study in swine was to verify the possibility of preventing the development of NH at the vein-graft anastomosis using a modified commercially available longitudinal stretch expanded polytetrafluoroethylene (ePTFE) Gore (W. L. Gore & Associates, Flagstaff, Ariz) graft (either standard or heparin-bonded) with an added handmade ePTFE radial stretch cuff at one end to reduce the compliance between the graft and the vein wall. METHODS: Twelve ePTFE stretch grafts (6 modified and 6 unmodified) were surgically placed as arterovenous grafts (AVGs) between the carotid artery and the external jugular vein in 6 pigs. In each pig, one modified graft was placed on one side and one corresponding unmodified graft on the other side as a control. In 4 pigs, standard stretch ePTFE Gore grafts were used, and in 2 pigs, heparin-bonded stretch Gore grafts were used; 2 pigs were also treated with antiplatelet drugs. All the implanted grafts had a total length of 8 cm and a diameter of 6 mm. The modified graft was realized by cutting a short segment of the commercially available graft lengthwise which was then sewn crosswise (rotated 90°) with the same diameter as the original graft and was then added to it. A Doppler ultrasound scan was used for monitoring the graft patency immediately, weekly, and before death. At death (21-28 days after implantation), artery, vein, and graft specimens were collected "en bloc" for histopathology. RESULTS: The modified grafts in the antiplatelet-treated animals were able to completely prevent NH development on vein wall (100% in 2 subjects) which was also reduced in antiplatelet untreated animals (66.5%, 96.4%, and 100% in 3 subjects, respectively). The modified standard stretch grafts and similarly modified heparin-bonded stretch grafts obtained the same good results in NH prevention. CONCLUSION: Data provide evidence of the efficacy of modified stretch ePTFE grafts with an added radial stretch cuff for the prevention of NH in swine models and support the hypothesis of the pivotal role of mismatch compliance between the graft and the vein wall in NH development. |
| | |
Authors:
|
Massimiliano Gessaroli; Cristiano Bombardi; Massimo Giunti; Maria Laura Bacci |
Publication Detail:
|
Type: - Date: 2011-9-22 |
Journal Detail:
|
Title: Journal of vascular surgery : official publication, the Society for Vascular Surgery [and] International Society for Cardiovascular Surgery, North American Chapter Volume: - ISSN: 1097-6809 ISO Abbreviation: - Publication Date: 2011 Sep |
Date Detail:
|
Created Date: 2011-9-27 Completed Date: - Revised Date: - |
Medline Journal Info:
|
Nlm Unique ID: 8407742 Medline TA: J Vasc Surg Country: - |
Other Details:
|
Languages: ENG Pagination: - Citation Subset: - |
Copyright Information:
|
Copyright © 2011 Society for Vascular Surgery. Published by Mosby, Inc. All rights reserved. |
Affiliation:
|
Vascular and Endovascular Surgery Unit, Infermi Hospital, Rimini, Italy. |
Export Citation:
|
APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
|
|
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
Previous Document: Management and prognosis of nonpulmonary large arterial disease in 25 patients with Behçet disease ...
Next Document: Compression therapy in mixed ulcers increases venous output and arterial perfusion.